Newborn Anemia

What is newborn anemia?

A baby who has anemia does not have enough red blood cells. The red blood cells carry oxygen in the blood and deliver it to the rest of the body.

Every baby becomes anemic 6 to 9 weeks after birth. This is called physiologic (or normal) anemia. Red blood cells (RBCs) get old and break down but the body makes new red blood cells. Babies cannot make new red blood cells quickly enough until to replace the lost ones until they are 1 month of age. Once the baby starts making new red blood cells, the red blood cell count gradually goes back to normal. Most babies do not have any symptoms from this natural process and do not need treatment.

What causes newborn anemia?

Besides normal anemia, newborns can become anemic due to:

• Blood loss. Sometimes the baby loses blood at the time of delivery, either into the mother's bloodstream or into the placenta.
• Rapid breakdown of red blood cells. This most commonly happens if the mother and baby do not have the same blood type.
• Lack of red blood cell production. It normally takes 1 month for a baby’s body to start making RBCs from their bone marrow. In some babies, there can be rare problems that cause lack of production to last longer. This can make the anemia worse. Lack of iron and some other nutrients, or certain infections can cause decreased production.
• Premature birth. Premature babies become anemic sooner than full-term infants because they start out with fewer red blood cells and their red blood cells break down faster. They also lose blood from frequent blood tests. Many premature babies become anemic before their body can make red blood cells. They may need a transfusion of blood. The smaller a premature baby is, the more likely he will need one or more blood transfusions in the first 2 months of life.

A baby who is anemic:

• looks pale or has a yellow skin tone
• may be sleepy or tired
• may get tired when feeding
• may have a fast heart rate and breathing rate when resting.

What is the treatment?

Anemia is a normal process for newborns and does not need to be treated unless it causes a problem for the baby.

• Blood test: Every baby in the special care nursery has a red blood cell count, or hematocrit, several times a week. It is expected that the blood count will gradually fall. A baby is not treated for anemia unless the baby develops symptoms of anemia or the blood count drops too low.
• Iron supplement: Iron is needed to make red blood cells. Premature babies need iron added to their diet. Your healthcare provider may recommend that you give your baby iron drops. Full term babies may not need iron supplements until they are much older.
• Blood Transfusion: A blood transfusion is a transfer of red blood cells to a baby through the veins. It increases the baby's red blood cell count.

  There are many different reasons for a blood transfusion. Sometimes a transfusion is needed as an emergency. If a baby rapidly loses a large amount of blood or if the blood count is so low that the heart and body are under stress from lack of oxygen, a blood transfusion can save the baby's life.

  At other times a transfusion is given to treat a specific symptom that is thought to be made worse by anemia. For example, a baby who is weak and tired and has a very low blood count may become stronger and eat better once the blood count is raised by a transfusion. Very premature babies may have low blood counts. Because of their age and prematurity, they are not expected to make blood for several weeks. In these cases a blood transfusion is given to boost the blood count.

  If a transfusion is necessary, your baby's doctor will discuss the reasons with you.

How is a blood transfusion given?

Blood to be given is matched against the baby's blood to make sure it is compatible. The blood is also tested to make as sure as possible that it is free of any infection that could be passed through the blood.

The blood is given to the baby into a vein with an intravenous (IV) line. The transfusion lasts about an hour. The baby is watched carefully during the transfusion but can be held during this time. The amount of blood given to the baby is relatively small. It is usually no more than a few tablespoons.

Sources of blood

Blood for transfusion comes from the blood bank in one of two ways. Usually the blood is donated by volunteer donors. This is called blood bank blood. It is also possible for family members to donate blood specifically for the baby. This is called directed-donor blood.

• Blood bank blood: All blood collected at the blood bank is donated by volunteers whose health is carefully screened. The blood is tested for infections that could be passed through blood. These infections include syphilis, hepatitis, HIV, and cytomegalovirus (CMV). CMV is a common virus which causes a mild cold in children and adults. However, CMV can be passed through blood transfusion and can cause more serious infections in premature babies. All blood used for premature infants is CMV negative; that is, it is donated by people who have not had CMV infections. HIV is the virus that causes AIDS. Because blood is now tested for viruses, the risk for getting AIDS or hepatitis through transfusion is very low.
• Directed-donor blood: Family members can donate blood for their baby. However, mothers cannot donate for their baby until 6 to 8 weeks after delivery. The donor blood must be a compatible blood type. All donors are screened for syphilis, hepatitis, HIV, and CMV. The blood is available for transfusion 48 hours after it is donated. If the transfusion needs to be done right away, there may not be time for this kind of blood donation. Research has shown that family donors do not offer any greater protection from infection than volunteer donors from the blood bank.

How long will the anemia last?

All babies outgrow the anemia during their first 2 months of life. Most babies who receive blood transfusions do not have any problems.